Geriatric assessment via telehealth feasible for older adults with cancer
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An advanced practice nurse-led clinic conducted via telehealth proved a safe approach for geriatric assessment implementation, according to study results presented at the virtual Oncology Nursing Society Congress.
The approach optimized engagement and communication among patients, their family members and caregivers while facilitating collaboration with members of both the primary and multidisciplinary care teams, according to researchers.
“The purpose of our intervention of telehealth in geriatric oncology was to provide an innovative approach that was safe for older adults,” Leana Cabrera Chien, MSN, RN, GCNS-BC, GNP-BC, geriatric nurse practitioner at City of Hope, said during a presentation. “[The results showed] we can provide the gold standard of care for the older adult with cancer with the implementation of a geriatric assessment in both settings of telehealth and usual care.”
Older adults with cancer are at elevated risk for severe symptoms if they contract the novel coronavirus.
Chien and colleagues within the advanced practice nurse-led geriatric consult clinic — which provides a holistic approach to geriatric oncology based on ASCO and National Comprehensive Cancer Network guidelines — used the electronic medical record to conduct geriatric assessments and implement interventions for this patient population via a telehealth platform.
Investigators offered 50 patients aged 65 years and older a traditional in-person clinic visit or a tele-video visit through the hospital’s telehealth platform between September 2019 and February of this year.
All patients received a self-administered geriatric assessment via the EMR, and they either completed the geriatric assessment before their visit or received assistance to do so during the visit.
Providers reviewed each component of the geriatric assessment during the visit to address the patient’s needs, and advanced practice nurses provided interventions — such as referrals to physical or occupational therapy — based on results of the assessment.
Key components of the assessments included patients’ functional status, comorbidities, polypharmacy, cognition, nutrition and social support.
“A plan of care is created and tailored to the unique needs of each patient,” Chien said.
Half of the patients (n = 25) opted for geriatric assessments via usual care and the other half chose to undergo assessment via telehealth. Patients in the usual care group were older (median age, 75 years vs. 72 years) and more likely to be female (88% vs. 76%). Researchers reported no significant difference in scores on the Vulnerable Elders Survey-13, Timed Up and Go test or cognition tests between groups.
Researchers are reviewing clinical outcomes between the usual care and telehealth groups. Their review will assess geriatric assessment domains such as mobility, cognition and nutrition; completion of interventions; and family or caregiver participation during visits. Chien and colleagues anticipate no difference in provision of care between groups.
“All patients completed the geriatric assessment regardless of setting, thus proving feasibility of utilizing the geriatric assessment via telehealth vs. usual care,” Chien said. “During COVID-19, strict visitor policies [have limited] the ability of patients to have family members present during in-person visits. Geriatric assessment via telehealth provides a forum for both the patient, family/caregiver and advanced practice nurse to facilitate communication. Telehealth also optimizes patient/family/caregiver engagement and decreases risk [for] COVID-19 exposure.”
Efforts to expand and improve access to care for older adults with cancer can eliminate barriers related to transportation or clinic space, ensure a standard of care is maintained and improve care coordination, Chien said.
“There also could be new telehealth roles, such as rooming and screening a patient via telehealth as they wait to see their providers,” Chien said. “Telehealth also allows the APN the benefit of practicing to their full scope of licensure.”
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Chien LC, et al. Telehealth in geriatric oncology: An advanced practice nurse (APN)-led clinic approach to implementing a geriatric assessment during COVID-19. Presented at: Oncology Nursing Society Congress (virtual meeting); April 20-29, 2021.
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